Typhus

Introduction

Typhus is a sudden severe illness caused by infection with Rickettsia bacteria.

Outbreaks of typhus tend to occur in developing countries and areas where there is poverty, homelessness, close human contact and poor sanitation.

The Rickettsia bacteria that cause typhus are carried by body lice, ticks, mites and fleas.

This page covers the main types:

epidemic typhus (the most serious form) – this type occurs in Africa, South America and Asia, and is transmitted by body lice

endemic typhus (the milder form of the disease) – it occurs throughout the world and is transmitted by ticks, mites and fleas

scrub typhus (also called Tsutsugamushi fever) – this type is caught from mites infected with Orientia tsutsugamushi bacteria, which live in heavy scrub vegetation in parts of rural southeast Asia, Oceania and northern Australia

Typhus is generally not a problem in the UK. But you may become infected abroad if you catch Rickettsia-infected lice from infested people or bedding (in budget accommodation or on a sleeper train, for example), or if you are bitten by a Rickettsia-infected tick, mite or flea.

How do you catch epidemic typhus?

Epidemic typhus is passed from human to human by body lice. These are not the same as head lice or pubic lice, which are a nuisance, but don't transmit disease.

The body lice become infected with Rickettsia prowazekii bacteria when they feed on the blood of an infected person.

If you catch these infected body lice (for example, by using a louse-infested blanket), their infected faeces will be deposited on your skin as they feed on your blood.

You only need to scratch a bite to rub the contaminated lice faeces into the tiny wound on your skin to become infected.

The patient may need to have hospital follow-up for some months after recovering from an attack of typhus to receive treatment for these long-term problems.

Brill-Zinsser disease

Some people who previously had epidemic typhus will develop a milder form of the disease years later called Brill-Zinsser disease.

This tends to happen when the bacteria were not properly killed off the first time and lie dormant (inactive) in the body. The bacteria then reactivate at a later date when the person's immune system is weak.

Brill-Zinsser disease will need treating again with antibiotics.

Can typhus be prevented?

There's currently no licensed vaccine for typhus.

The best way to avoid becoming infected with typhus is to avoid areas or crowds where louse-borne typhus is a problem, and take care to avoid contact with ticks, mites and fleas.

Wash and change your clothes regularly, and don't use any bedding or clothing that could be infested with body lice.

If you're about to travel abroad to an area where typhus is a problem, talk to your doctor about taking weekly doses of doxycycline to prevent infection. This is especially effective against scrub typhus.